The decision permits Governor John Kasich, a Republican who otherwise opposes the reform law known as the Affordable Care Act, to bypass the state’s Republican-dominated legislature to expand Medicaid, a move strongly opposed by many Ohio conservatives.

The Ohio Controlling Board, a special legislative panel composed of six legislators and one Kasich appointee, approved by a 5-2 vote accepting $2.5 billion in federal money, which the governor has said would cover 275,000 additional low-income Ohio residents, starting in January.

Kasich endorsed the expansion last February, raising hopes that Ohio would join 25 states and the District of Columbia in either moving forward with expanding Medicaid or requesting modifications to the plan. Medicaid expansion is a major plank of Obama’s health reform law, which aims to ensure that all Americans have access to affordable health insurance.

Some conservatives are expected to sue over the expansion. Nearly 40 Republican legislators last week formally protested Kasich’s request to the board, which represents a majority of the Republican caucus in the state House.

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